MyAccess Sign In

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Delirium is a nonspecific warning sign, like fever or hypotension, indicating that something serious may be wrong and requires further investigation. Thirty-nine percent of inpatients with delirium die within one year. Do not ignore this red flag.

Delirium is associated with increased mortality, morbidity, and length of stay. Estimates of annual US health care costs attributed to delirium range from $40 billion to $150 billion. Delirious patients require extra care following discharge from acute inpatient units and are at increased risk of being discharged to a skilled nursing facility rather than directly home. Patients often suffer from frightening memories of delirious episodes while hospitalized. Such experiences may result in appreciable anxiety and preoccupation long after delirium has cleared, impacting the patient’s quality of life for months to years. Family members are often distressed by the changed demeanor and behavior of their loved one, making care and support more challenging.

PATHOPHYSIOLOGY

The central feature of delirium is an acute disturbance of consciousness accompanied by altered cognition or perception. Disruptions in brain function occur in the brainstem, thalamus, prefrontal cortex, fusiform cortex, and parietal lobes. This widespread cortical dysfunction is typically associated with diffuse and symmetric slowing of electrical activity on electroencephalography (EEG), although fast electrical activity occurs in some cases, especially in alcohol or sedative withdrawal.

The diagnosis of delirium requires diminished attention and awareness, evolving over a short period of time (hours to days), waxing and waning in severity, and associated with other disturbances in cognition, such as memory deficits and disorientation. Delirium cannot be wholly explained by a pre-existing neurologic disorder. History, physical examination, laboratory testing, and imaging should reveal one or more inciting factors, such as electrolyte disturbances, infections, adverse effects of medications, or drug and alcohol withdrawal syndromes.